amphotericin-b and Craniocerebral-Trauma

Mucormycosis is an uncommon opportunistic fungal infection caused by Zygomycetes. It usually affects immunocompromised, diabetic and trauma patients with infected wounds. We report a case of disseminated infection secondary to facial cutaneous mucormycosis caused by Saksenaea vasiformis in a diabetic patient who had a farming accident causing him severe head injury. The patient was treated with a combination of surgical debridement and antifungal therapy with liposomal amphotericin B, but he had a slow and fatal outcome. In cases of tissue necrosis following trauma involving wound contact with soil (i.e., potential fungal contamination), testing for the presence of Zygomycetes fungi such as S. vasiformis in both immunocompetent and immunocompromised patients is crucial. The reason is that this infection usually has a rapid progression and may be fatal if appropriate treatment is not administered.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Craniocerebral Trauma; Dermatomycoses; Diabetes Complications; Diabetes Mellitus; Humans; Immunocompromised Host; Male; Middle Aged; Molecular Sequence Data; Mucorales; Mucormycosis; Sepsis

Gas-containing brain abscesses are rare, and the vast majority are caused by Clostridium perfringens. Significant simultaneous fungal infection in a bacterial abscess is even rarer. We present such a case and review the literature.. A 21-month-old male patient sustained a penetrating head injury in a barnyard, developed a gas-containing left parietal brain abscess, and presented with high fever, galeal swelling, and seizure.. The patient initially underwent debridement of his wound and then repeated aspirations. The initial cultures revealed pure growth of Clostridium perfringens. Despite appropriate antibiotic therapy, serial neuroimaging did not demonstrate a decrease in the size of the cavity. An excision had to be undertaken 6 weeks after the injury. The culture from the excised specimen revealed an unexpected growth of a saprophytic and opportunistic fungus, Myceliophthora thermophila. Antifungal treatment consisting of the administration of liposomal amphotericin B and itraconazole was then performed. The child was well and neurologically intact 6 months after the excision.. Our review revealed 38 cases of clostridial brain abscess in the literature. Despite the reputation of the organism, the outcome with clostridial brain abscesses was relatively benign. The main characteristics of clostridial brain abscesses are highlighted, with reference to their optimal treatment. Our review also revealed that fungal infection after a penetrating head injury is extremely rare and often fatal. Our case seems to be the first in the medical literature with growth of M. thermophila as a causative agent for intracranial suppuration.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Brain Abscess; Craniocerebral Trauma; Gas Gangrene; Humans; Infant; Itraconazole; Male; Mycoses; Tomography, X-Ray Computed

A case of coccidioidal meningitis following an open-head injury is presented. A 6-year-old boy was ejected from a motor vehicle as it was driven over a cliff, resulting in a severe open-skull fracture with grossly contaminated wounds. The accident occurred in an area in which coccidioidomycosis is endemic, and the causative agent, Coccidioides immitis, is found in high concentration in the soil. In addition to fracture reduction, the child received a course of intrathecal and intravenous amphotericin and achieved a satisfactory clinical response.

Topics: Amphotericin B; California; Child; Coccidioidomycosis; Craniocerebral Trauma; Humans; Male; Meningitis; Tomography, X-Ray Computed; Wound Infection

The authors describe a case of human cerebral mucormycosis following open head trauma and craniotomy, and discuss possible roles of steroids and antibiotic therapy in its pathogenesis. They suggest that the common usage of prolonged broad-spectrum chemoprophylaxis in head trauma may require critical review.

Topics: Amphotericin B; Anti-Bacterial Agents; Brain Diseases; Cerebrospinal Fluid; Child; Craniocerebral Trauma; Craniotomy; Fungi; Humans; Male; Mucormycosis; Postoperative Complications; Steroids

Topics: Amphotericin B; Candidiasis; Child; Craniocerebral Trauma; Eye Diseases; Humans